严重前囊膜浑浊的新式手术方法疗效分析

[摘要] 目的 探索一种新式的治疗严重前囊膜浑浊（ACO）的安全、简便的手术方法。 方法 方便选取2010年11月―2015年11月期间6例白内障超声乳化吸除联合人工晶状体（IOL） 植入术后发生严重ACO的患者（北京大学第三医院3例，中日友好医院3例），前囊膜与IOL间注入玻璃酸钠，使用囊膜剪轮辐状放射状 剪开 纤维组织及前囊膜，形成足够大小的前囊口。随访患者术后1炎症反应情况，术后1个月、6个月的矫正视力及前囊口大小情况。 结果 术后1周患者前节无明显炎症反应，术后1个月视力0.25～0.5，较术前提高5～8行，术后6个月时视力0.3～0.5，较术前提高6～8行，术后1个月及6个月时前囊口直径由术前的0～1 mm扩大至5～7 mm。 结论 新的手术方式可有效解除前囊膜的收缩，解除中央纤维组织的遮挡，显著提高视力，术后炎症反应轻，且对悬韧带损伤小，是一种安全有效的手术方式。

[关键词] 前囊浑浊；前囊收缩；放射状切开

[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2017）05（b）-0102-03

[Abstract] Objective To explore a safe and simple operation method of anterior capsular turbidity. Methods 6 cases of severe ACO patients after the phacoemulsification and intraocular lens implantation from November 2010 to November 2015 were convenient selected（3 cases were in the third hospital of Beijing University and 3 cases were in the China-Japan Friendship Hospital）， and the sodium hyaluronate was injected in the anterior capsule and IOL， and the fiber tissue and anterior capsule were cut thus forming the large enough anterior capsular opening， and the inflammatory reactions at 1 weeks after operation， correctional eyesight and anterior capsular opening size in 1 months and 6 months after operation of patients were followed-up. Results There were no obvious inflammatory reactions of patients in 1 weeks after operation， and the vision increased from 0.25 to 0.5， increasing by 5～8 lines compared with that before operation， and the vision in 6 months after operation was 0.3～0.5， increasing by 6～8 lines compared with that before operation， and the anterior capsular opening diameter in 1 month and 6 month after operation increased from 0～1 mm before operation to 5～7 mm after operation. Conclusion The new operation method can effectively release the contraction of anterior capsule and occlusion of central filamentary microstructure and obviously improve the vision with mild postoperative inflammatory reactions and small injury to suspensory ligament， and it is a safe and effective operation method.

[Key words] Anterior capsular turbidity； Anterior capsular contraction； Radial incision

前囊膜浊（anterior capsular opacification，ACO）或囊膜收缩综合征（capsular contraction syndrome，CCS）是连续环形撕囊（continuous curvilinear capsulorhexis， CCC）的并发症之一。ACO引起白内障超声乳化吸除联合人工晶状体（intraocular lens， IOL） 植入术后前囊口缩小、前囊膜浑浊、IOL位置改变等，导致视力下降、眩光等症状。ACO是由残余晶状体上皮细胞增殖，向肌纤维母细胞转化，产生多过的胶原组织引起的[1]。在这些纤维细胞中平滑肌细胞α肌动蛋白可导致前囊收缩，甚至可导致撕囊口完全闭塞。严重的ACO采用激光等传统方法治疗效果不佳，且易产生并发症，该文方便选取2010年11月―2015年11月就诊的6例患者，探讨一种新的严重ACO的手术方法，并对手术效果进行评价，现报道如下。

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（收稿日期：2017-02-14）